MS Management: 4 Things to Know About Relapses
1. What are MS Relapses?
Relapses, attacks or flare-ups are exacerbations of multiple sclerosis (MS) that cause the development of new symptoms or the worsening of old symptoms. Depending on many factors, MS relapses can be mild or severe and some patients may even feel incapable of continuing with their normal activities at home or work. The term is used when the attack lasts at least 24 hours, but it can take from a few days to weeks or months, and it must be separated from the previous attack by at least 30 days. Relapses are always different from each other, having different symptoms each time and in each patient.
“For example, the exacerbation might be an episode of optic neuritis (caused by inflammation of the optic nerve that impairs vision), or problems with balance or severe fatigue,” explain the National Multiple Sclerosis Society about the topic. “Some relapses produce only one symptom (related to inflammation in a single area of the central nervous system) while other relapses cause two or more symptoms at the same time (related to inflammation in more than one area of the central nervous system).”
Dr. Fred Lublin, a renowned multiple sclerosis (MS), helped launch the Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting, with the John F. Kurtzke Memorial Lecture he titled “Do Relapses Really Matter?”
2. What Causes MS Relapses?
Patients with multiple sclerosis experience relapses due to an inflammation in the central nervous system, which damages the myelin. The myelin is a fatty and white substance that forms the lining of some nerve cells and when damaged, the transmission of nerve impulses is either slowed down or disrupted, which is what causes the symptoms.
Relapsing-remitting multiple sclerosis (RRMS) is the most common type of the disease and it is characterized by acute exacerbations followed by periods of remission. This occurs since the inflammatory process gradually comes to an end and returns after a while. Remission does not always mean that the symptoms fully disappear, but instead that they are temporarily asleep. While some patients regain their health as before the relapse, other patients continue with some ongoing symptoms.
3. How are Relapses Treated?
Not all patients experiencing relapses need treatment. Some mild sensory alterations, like numbness, pins-and-needle sensations, or peaks of fatigue that don’t interfere with the patient’s normal life are often not treated. However, in the case of severe relapses, such as loss of vision, severe weakness. or poor balance physicians usually recommend treatment. Since the patient’s mobility, safety and overall ability to function are compromised, neurologists may prescribe a short course of high-dose corticosteroids in order to decrease inflammation and end the relapse faster.
The most common course of treatment includes the intravenous administration of Solu-medrol® (methylprednisolone) or a high dose of oral Deltasone® (prednisone), for three to five days. However, corticosteroids are found ineffective in the long-term treatment of MS. Other treatment options include H.P. Acthar Gel (ACTH) for patients who cannot deal with the side effects of high-dose corticosteroids, for whom corticosteroids are ineffective, who don’t have access to intravenous therapy or who have difficulties receiving medication intravenously, or plasmapheresis (plasma exchange) for the cases that do not respond well to standard steroid treatment.
4. Is Restorative Rehabilitation Helpful?
In addition to medication to help end the relapses, patients may also be recommended restorative rehabilitation to help cope with the consequences of the attack. The purpose of a restorative rehabilitation program is to help patients regain or maintain their normal functions needed for the quotidian. Right after an MS relapse, patients may be advised to seek restorative rehabilitation in order to get back on track.
“The members of the rehab team — including physical therapists, occupational therapists, speech/language pathologists and cognitive remediation specialists — address problems with mobility, dressing and personal care, role performance at home and work, and overall fitness. They also provide evaluation and treatment of speech and swallowing difficulties and problems with thinking and memory that may have appeared or worsened during the exacerbation.”
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